#287 How to Slow the Flow: NSAIDs for Heavy Menstrual Bleeding
CLINICAL QUESTION
In premenopausal heavy menstrual bleeding without pathological cause, do nonsteroidal anti-inflammatory drugs (NSAIDs) improve patient outcomes?
BOTTOM LINE
Based on low-quality evidence, NSAIDs reduce relative mean menstrual blood loss by ~30%, and ~20-50% fewer sanitary products used than placebo. Effects on bleeding duration are inconsistent.
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EVIDENCE
Focused on randomized, placebo-controlled trials (RCTs). Menorrhagia, when defined: >80ml/cycle.
Naproxen: 2 cross-over RCTs, 4 patients each. Baseline blood loss ~140ml. After 2 menstrual cycles of each treatment:1-3
- Mean blood loss decreased ~30% over placebo.1-3
- In 1 RCT, 79% felt naproxen better than placebo.3
- No effect on bleeding duration.3
- Ibuprofen 1200mg/day decreased mean blood loss ~25% over placebo.
- Ibuprofen 600mg/day: not different from placebo.
- No effect bleeding duration.
- Largest RCT: 80 women, 3 consecutive cycles.5
- “Relief” of menorrhagia (not defined): 86% versus 20%, number needed to treat=2.
- Number of pads per day: 15 at baseline, 7 on mefenamic acid (placebo not stated).
- Number of bleeding days: 10 at baseline, 4 on mefenamic acid (placebo not stated).
- 3 RCTs (2 cross-over, total 49 patients): mefenamic acid better than placebo.
- Mean blood loss ~10-40% lower than placebo.6-8
- “Responded” (not defined): 79% versus 18% (placebo).6,9
- 1 cross-over RCT, 15 patients: no difference in blood loss.10
- 1 RCT, 68 women, only 1 completed all study follow-up.11
- Median number of pads used (baseline unknown): 21 versus 10 (diclofenac).
- Number of bleeding days (baseline unknown): 6 versus 4 (diclofenac).
- 1 cross-over RCT, 35 women.12
- Both groups decreased mean blood loss ~47% from baseline.
- Days of bleeding in both groups decreased 0.8.
- Number of tampons decreased from ~31 at baseline to ~24.
- Volume of blood loss does not correlate with patient experience.13
- NSAIDs are used immediately before and during menses (example: mefenamic acid 500mg TID from menstruation onset to end6).
- Mefenamic acid costs ~$20/cycle; naproxen and ibuprofen ~$4 each.14-16
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what is the exact posologia for ibuprofen and napproxen?
confirm my thoughts and knowledge
My biggest question would have been the proper dosing and the actual podcast ending discussed this and helped with that so thanks!
cost reference important